Provider Demographics
NPI:1649600974
Name:WASHINGTON, CARL JR
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:WASHINGTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 S MACARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-6370
Mailing Address - Country:US
Mailing Address - Phone:229-336-2247
Mailing Address - Fax:
Practice Address - Street 1:198 S MACARTHUR DR
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-6370
Practice Address - Country:US
Practice Address - Phone:229-336-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACARAKEEM8Medicaid